HIV self-testing: breaking the barriers to uptake of testing amongmen and adolescents in sub-Saharan Africa, experiences from STAR demonstration projects in Malawi, Zambia and Zimbabwe
HIV self-testing: breaking the barriers to uptake of testing amongmen and adolescents in sub-Saharan Africa, experiences from STAR demonstration projects in Malawi, Zambia and Zimbabwe
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DOI：
10.1002/jia2.25244
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发表时间：
2019-03-01
影响因子：
6
通讯作者：
Corbett, Elizabeth L.
中科院分区：
文献类型：
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作者：
Hatzold, Karin;Gudukeya, Stephano;Corbett, Elizabeth L.
前言社会、结构和制度障碍阻碍了艾滋病毒检测的普及。艾滋病毒自我检测(HIVST)显示，包括男性、年轻人和首次检测者在内的其他未得到充分服务的优先群体很有希望接受艾滋病毒。在这里，我们使用HIVST试剂盒接受者的特征来调查HIVST在三个非洲国家扩大规模期间向这些优先群体提供的服务。方法试剂盒分销商从所有客户那里收集个人级别的年龄、性别和检测历史。这些数据按国家(马拉维、赞比亚和津巴布韦)按五种分配模式汇总和分析：当地社区分销商(CBD：上门、街道和当地场所)、工作场所分配(WD)、融入艾滋病毒检测服务(IHTs)或公共卫生设施(IPHF)，以及在创造自愿男性包皮环切术(VMMC)需求期间。结果在2015年5月至2017年7月期间，马拉维(172,830)、赞比亚(190,787)和津巴布韦(265,091)分发了628,705个HIVST试剂盒。社区模式是最早建立的，占分发试剂盒的519,658件(82.7%)，退还旧试剂盒275,419件(53.0%)。随后的模型多样化通过IHTS交付了54,453个(8.7%)测试包，通过VMMC交付了23,561个(3.7%)，通过IPHF交付了21,183个(3.4%)，通过WD交付了9850个(1.7%)。男性购买了294,508件(48.2%)，其中263,073件(43.1%)流向了16岁至24岁的年轻人。男性自测者首次测试的比例(65,577人；22.3%)高于女性(54,096人；17.1%)，这一点在津巴布韦(16.2%对11.4%)、赞比亚(25.4%对17.7%)和马拉维(27.9%对25.9%)都很明显。首次测试的比例最高的是年轻男性(16岁至24岁)和老年男性(50岁)(国家范围分别为18.7%至35.9%和13.8%至26.8%)。在12个接生点中，大多数IHTS客户选择HIVST而不是标准HTS，选择HIVST的人艾滋病毒感染率较低，这可能是由于自我选择。结论在马拉维、赞比亚和津巴布韦，使用几种不同模式大规模提供HIVST的男性、年轻人和首次检测人员的比例很高，其中一些人可能没有进行其他测试。由于男性和年轻人在基于设施和社区的标准艾滋病毒检测中的接受度有限，像HIVST这样对男性和青年敏感的创新方法可能对实现联合国艾滋病规划署2020年快车道目标至关重要。
IntroductionSocial, structural and systems barriers inhibit uptake of HIV testing. HIV self-testing (HIVST) has shown promising uptake by otherwise underserved priority groups including men, young people and first-time testers. Here, we use characteristics of HIVST kit recipients to investigate delivery to these priority groups during HIVST scale-up in three African countries.MethodsKit distributors collected individual-level age, sex and testing history from all clients. These data were aggregated and analysed by country (Malawi, Zambia and Zimbabwe) for five distribution models: local community-based distributor (CBD: door-to-door, street and local venues), workplace distribution (WD), integration into HIV testing services (IHTS), or public health facilities (IPHF) and during demand creation for voluntary male medical circumcision (VMMC). Used kits were collected and re-read from CBD and IHTS recipients.ResultsBetween May 2015 and July 2017, 628,705 HIVST kits were distributed in Malawi (172,830), Zambia (190,787) and Zimbabwe (265,091). Community-based models, the first to be established, accounted for 519,658 (82.7%) of kits distributed, with 275,419 (53.0%) used kits returned. Subsequent model diversification delivered 54,453 (8.7%) test-kits through IHTS, 23,561 (3.7%) through VMMC, 21,183 (3.4%) through IPHF and 9850 (1.7%) through WD. Men took 294,508 (48.2%) kits, and 263,073 (43.1%) went to young people (16 to 24years). A higher proportion of male self-testers (65,577; 22.3%) were first-time testers than women (54,096; 17.1%) with this apparent in Zimbabwe (16.2% vs. 11.4%), Zambia (25.4% vs. 17.7%) and Malawi (27.9% vs. 25.9%). The highest proportions of first-time testers were in young (16 to 24years) and older (>50years) men (country-ranges: 18.7% to 35.9% and 13.8% to 26.8% respectively). Most IHTS clients opted for HIVST in preference to standard HTS in each of 12 delivery sites, with those selecting HIVST having lower HIV prevalence, potentially due to self-selection.ConclusionsHIVST delivered at scale using several different models reached a high proportion of men, young people and first-time testers in Malawi, Zambia and Zimbabwe, some of whom may not have tested otherwise. As men and young people have limited uptake under standard facility-and community-based HIV testing, innovative male- and youth-sensitive approaches like HIVST may be essential to reaching UNAIDS fast-track targets for 2020.